Provider Demographics
NPI:1871626903
Name:MOHS SURGERY SPECIALISTS, LLC
Entity type:Organization
Organization Name:MOHS SURGERY SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:ANTROBUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-763-9611
Mailing Address - Street 1:4950 ESSEN LANE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809
Mailing Address - Country:US
Mailing Address - Phone:225-763-9611
Mailing Address - Fax:225-763-9699
Practice Address - Street 1:4950 ESSEN LANE
Practice Address - Street 2:SUITE 301
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808
Practice Address - Country:US
Practice Address - Phone:225-763-9611
Practice Address - Fax:225-763-9699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA435829281BOtherBLUE CROSS
LA5CN59Medicare ID - Type Unspecified